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INJURY AND ILLNESS INCIDENT REPORT Michigan …

INJURY AND ILLNESS INCIDENT REPORT Phone Time of event If the employee died, when did death occur? Date of death According to Public Law of 1970 (P.L. 91-596) and Michigan Occupational Safety and Health Act 154, P.A. 174, Part 11, Michigan Administrative Rule for Recording and Reporting Of Injuries and Illnesses, you must keep this form on file ...

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